Psychiatrie und Psychotherapie up2date 2009; 3(03): 197-212
DOI: 10.1055/s-0028-1090210
Störungsübergreifende Themen und Methoden

Suizidalität

Erik Lauterbach
,
Thorsten Kienast
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Kernaussagen

  • Suizide und Suizidversuche stellen weltweit eine erhebliche Herausforderung für das öffentliche Gesundheitswesen dar.

  • Major Depression und bipolare Störungen sind mit der höchsten Suizidrate assoziiert, insbesondere bei komorbider Abhängigkeitserkrankung.

  • Hauptrisikofaktoren für einen Suizid sind neben dem Vorliegen einer psychiatrischen Erkrankung hohes Alter, männliches Geschlecht, fehlender Zugang zu fachspezifischer Behandlung und Arbeitslosigkeit.

  • Wichtigster Prädiktor ist ein Suizidversuch in der Vorgeschichte.

  • Ätiologisch spielt eine verminderte serotonerge Neurotransmission, insbesondere im präfrontalen Kortex, eine entscheidende Rolle.

  • Lithium hat eine sichere suizidprotektive Wirkung bei bipolarer Störung, mit leicht geringerer Wirksamkeit auch bei unipolaren Depressionen oder rezidivierenden depressiven Störungen; Clozapin ist wirksam in der Suizidprophylaxe bei Schizophrenie.



Publication History

Publication Date:
11 May 2009 (online)

© Georg Thieme Verlag KG Stuttgart · New York

 

  • Literatur

  • Kreitmann N. Epidemiologie von Suizid und Parasuizid.. Nervenarzt 1980; 51: 131-139
    Google Scholar
  • Winokur G, Black DW. Psychiatric and medical diagnoses as risk factors for mortality in psychiatric patients: a case-control study.. Am J Psychiatry 1987; 144: 208-211
    Google Scholar
  • Hagnell O, Lanke J, Rorsman B. Suicide rates in the Lundby study: mental illness as a risk factor for suicide.. Neuropsychobiology 1981; 7: 248-253
    Google Scholar
  • Lejoyeux M, Léon E, Rouillon F. Prevalence and risk factors of suicide and attempted suicide.. Encephale 1994; 20: 495-503
    Google Scholar
  • Schneider B, Wetterling T, Sargk D. et al. Axis I disorders and personality disorders as risk factors for suicide.. Eur Arch Psychiatry Clin Neurosci 2006; 256: 17-27
    Google Scholar
  • Jamison KR. Suicide in manic depressive illness. In: Goodwin FK, Jamison KR, eds Manic-depressive illness.. London, Oxford University Press: 1990
    Google Scholar
  • Wolfersdorf M, Mäulen B. Suizidprävention bei psychisch Kranken. In: Wedler H, Wolfersdorf M, Welz R, Hrsg Therapie bei Suizidgefährdung. Ein Handbuch.. Regensburg,Roderer: 1992: 175-197
    Google Scholar
  • Dumais A, Lesage AD, Alda M. et al. Risk factors for suicide completion in major depression: a case-control study of impulsive and aggressive behaviors in men.. Am J Psychiatry 2005; 162: 2116-2124
    Google Scholar
  • Beck AT, Brown G, Steer RA. Prediction of eventual suicide in psychiatric inpatients by clinical ratings of hopelessness.. J Consult Clin Psychol 1989; 57: 309-310
    Google Scholar
  • Ringel E. Der Selbstmord. Abschluss einer krankhaften psychischen Entwicklung.. Wien: Mandrich 1954
    Google Scholar
  • Hawton K, Zahl D, Weatherall R. Suicide following deliberate self-harm: long-term follow-up of patients who presented to a general hospital.. Br J Psychiatry 2003; 182: 537-542
    Google Scholar
  • Bronisch T. Der Suizid: Ursachen, Warnsignale, Prävention.. München: Beck 1995
    Google Scholar
  • Platt S, Hawton K, Kreitman N. et al. Recent clinical and epidemiological trends in parasuicide in Edinburgh and Oxford: a tale of two cities.. Psychol Med 1988; 18: 405-418
    Google Scholar
  • Tondo L, Albert MJ, Baldessarini RJ. Suicide rates in relation to health care access in the United States: an ecological study.. J Clin Psychiatry 2006; 67: 517-523
    Google Scholar
  • Borg SE, Ståhl M. Prediction of suicide. A prospective study of suicides and controls among psychiatric patients.. Acta Psychiatr Scand 1982; 65: 221-232
    Google Scholar
  • Mann JJ, Waternaux C, Haas GL. et al. Toward a clinical model of suicidal behavior in psychiatric patients.. Am J Psychiatry 1999; 156: 181-189
    Google Scholar
  • Nordström P, Asberg M, Aberg-Wistedt A. et al. Attempted suicide predicts suicide risk in mood disorders.. Acta Psychiatr Scand 1995; 92: 345-350
    Google Scholar
  • Oquendo MA, Currier D, Mann JJ. Prospective studies of suicidal behavior in major depressive and bipolar disorders: what is the evidence for predictive risk factors?. Acta Psychiatr Scand 2006; 114: 151-158
    Google Scholar
  • Schmidtke A, Häfner H. The Werther effect after television films: new evidence for an old hypothesis.. Psychol Med 1988; 18: 665-676
    Google Scholar
  • Baldessarini RJ, Hennen J. Genetics of suicide: An overview.. Harv Rev Psychiatry 2004; 12: 1-13
    Google Scholar
  • McGuffin P, Marusic A, Farmer A. What can psychiatric genetics offer suicidology?. Crisis 2001; 22: 61-65
    Google Scholar
  • Li D, He L. Meta-analysis supports association between serotonin transporter (5-HTT) and suicidal behavior.. Mol Psychiatry 2007; 12: 47-54
    Google Scholar
  • Rujescu D, Thalmeier A, Möller HJ. et al. Molecular genetic findings in suicidal behavior: what is beyond the serotonergic system?. Arch Suicide Res 2007; 11: 17-40
    Google Scholar
  • Asberg M, Träskman L, Thorén P. 5-HIAA in the cerebrospinal fluid. A biochemical suicide predictor?. Arch Gen Psychiatry 1976; 33: 1193-1197
    Google Scholar
  • Arango V, Underwood MD, Gubbi AV. et al. Localized alterations in pre- and postsynaptic serotonin binding sites in the ventrolateral prefrontal cortex of suicide victims.. Brain Res 1995; 688: 121-133
    Google Scholar
  • Boldrini M, Underwood MD, Mann JJ. et al. More tryptophan hydroxylase in the brainstem dorsal raphe nucleus in depressed suicides.. Brain Res 2005; 1041: 19-28
    Google Scholar
  • Oquendo MA, Placidi GP, Malone KM. et al. Positron emission tomography of regional brain metabolic responses to a serotonergic challenge and lethality of suicide attempts in major depression.. Arch Gen Psychiatry 2003; 60: 14-22
    Google Scholar
  • Coryell W, Schlesser M. The dexamethasone suppression test and suicide prediction.. Am J Psychiatry 2001; 158: 748-753
    Google Scholar
  • Mann JJ. Neurobiology of suicidal behaviour.. Nat Rev Neurosci 2003; 4: 819-828
    Google Scholar
  • Hammad TA, Laughren TP, Racoosin JA. Suicide rates in short-term randomized controlled trials of newer antidepressants.. J Clin Psychopharmacol 2006; 26: 203-207
    Google Scholar
  • Simon GE, Savarino J, Operskalski B. et al. Suicide risk during antidepressant treatment.. Am J Psychiatry 2006; 163: 41-47
    Google Scholar
  • Gibbons RD, Brown CH, Hur K. et al. Early evidence on the effects of regulators' suicidality warnings on SSRI prescriptions and suicide in children and adolescents.. Am J Psychiatry 2007; 164: 1356-1363
    Google Scholar
  • Hennen J, Baldessarini RJ. Suicidal risk during treatment with clozapine: a meta-analysis.. Schizophr Res 2005; 73: 139-145
    Google Scholar
  • Baldessarini RJ, Tondo L, Davis P. et al. Decreased risk of suicides and attempts during long-term lithium treatment: a meta-analytic review.. Bipolar Disord 2006; 8: 625-639
    Google Scholar
  • Guzzetta F, Tondo L, Centorrino F. et al. Lithium treatment reduces suicide risk in recurrent major depressive disorder.. J Clin Psychiatry 2007; 68: 380-383
    Google Scholar
  • Thies-Flechtner K, Müller-Oerlinghausen B, Seibert W. et al. Effect of prophylactic treatment on suicide risk in patients with major affective disorders. Data from a randomized trial.. Pharmacopsychiatry 1996; 29: 103-107
    Google Scholar
  • Collins JC, McFarland BH. Divalproex, lithium and suicide among Medicaid patients with bipolar disorder.. J Affect Disord 2008; 107: 23-28
    Google Scholar
  • Tarrier N, Taylor K, Gooding P. Cognitive-behavioral interventions to reduce suicide behavior: a systematic review and meta-analysis.. Behav Modif 2008; 32: 77-108
    Google Scholar
  • Lauterbach E, Felber W, Müller-Oerlinghausen B. et al. Adjunctive Lithium treatment in the prevention of suicidal behaviour in depressive disorders: a randomised, placebo-controlled, 1-year trial.. Acta Psychiatr Scand 2008; 118: 469-479
    Google Scholar